Predictive Factors Of In-hospital Mortality Research Articles

PROMPT ADMISSION AND INTERVENTION SIGNIFICANTLY REDUCE IN-HOSPITAL MORTALITY FOR ACUTE PULMONARY EMBOLISM

Although acute pulmonary embolism (APE) may be fatal and several guidelines recommend prompt initiation of anticoagulation if suspicion for PE is high, it is still uncertain whether the delay of admission and intervention after the appearance of symptoms may worsen the outcome in patients with APE. We retrospectively analyzed the medical records of the consecutive 108 patients with APE who were diagnosed from May 1996 through December 2013. Patients consisted of two groups according to the timing of admission after the appearance of symptoms; delayed - group (DL-G) admitted later than 48 hours and prompt-group (P-G) within 48 hours. We evaluated the differences between two groups in terms of the clinical and hemodynamic data and in-hospital mortality. 108 patients (34.3% male, mean age 61±14 years old) were divided into DL-G (n=42; 38.9%) and P-G (n=66; 61.1%). In-hospital mortality had occurred in 16 patients (14.8%), and was significantly higher in DL-G compared than in P-G (26.2% vs. 7.6%; p=0.008). There were significant differences in male gender, heart rate on admission and the value of hemoglobin levels (47.6 vs 25.8%, p=0.024, 90.5 vs 68.2%; p= 0.007, 96.3 vs. 79.5 / bpm; p=0.006, 13.0 vs 11.9 g/dl, p= 0.024, respectively). The significant differences was not found in age, prevalence of deep vein thrombus, prevalence of massive PE, systolic blood pressure on admission, PaCO2 and PaO2 / FiO2 ratio. (61.8 ± 12.6 vs. 59.7 ± 16.3 year old; p=0.45, 73.4 vs 79.2%; p= 0.493, 23.8 vs. 22.7%; p=0.89, 108 ± 47 vs. 110 ± 36 mmHg, 36.4 ± 17.2 vs. 35.9 ± 9.5 Torr; p=0.85, 229 ± 123 vs. 234 ± 117; p=0.10, respectively). Multivariate logistic regression analysis revealed the delayed admission was an independent predictive factor for in-hospital mortality with adjusted odds ratio of 4.6 (95% confidence interval 1.2 to 17.7, p = 0.025) even after adjusting for age, gender and heart rate on admission, and the severity of APE. The present study demonstrated that the timing of admission and intervention the appearance of symptoms related to the outcome of APE. , This finding strongly suggesting importance of the prompt admission and intervention.

Predictive factors of in-hospital mortality in very old patients following rapid response team activation

The number of very old patients (80 years old) with chronic illness and functional impairment requiring major medical attention is increasing. Rapid Response Teams (RRT) were implemented to improve the recognition and response to deteriorating ward patients. However, the characteristics and outcomes of very old patients assisted by RRT during hospitalization are not well described.

Predicting risk factors for rebleeding, infections, mortality following peptic ulcer bleeding in patients with cirrhosis and the impact of antibiotics prophylaxis at different clinical stages of the disease.

BackgroundInfections in cirrhotic patients with upper gastrointestinal bleeding are a common event causing severe complication and mortality. This study aimed to identify risk factors that may predict rebleeding, bacterial infections, and the impact of antibiotic prophylaxis on mortality at different stages of cirrhosis following acute peptic ulcer bleeding (PUB).MethodsA hospital-based retrospective cohort study was conducted on 235 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures between January 2008 and January 2014 (n = 235); of these, 88 patients received prophylactic intravenous ceftriaxone (antibiotic group) and 147 patients did not (nil-antibiotic group). The recorded outcomes were length of hospital stay, bacterial infection, rebleeding, and in-hospital mortality.ResultsForty-eight (20.4 %) patients experienced ulcer rebleeding and 46 (19.6 %) developed bacterial infections. More patients suffered from infection and recurrent bleeding in the nil-antibiotic group than the antibiotic group (25.2 % vs. 10.2 %, p = 0.005 and 30.6 % vs. 3.4 %; p < 0.001, respectively). The predictive risk factors for rebleeding were the Rockall score (p = 0.004), units of blood transfusion (p = 0.031), and no antibiotic prophylaxis (p <0.001); for bacterial infections, they were the Child-Pugh score (p = 0.003), active alcoholism (p = 0.035), and no antibiotic prophylaxis (p = 0.009). Overall, 40 (17 %) patients died during hospitalization. The Rockall score and rebleeding were predictive factors for in-hospital mortality. In subgroup analysis, survival was significantly reduced in decompensated patients (p = 0.034).ConclusionsThis study suggests that antibiotic prophylaxis after endoscopic hemostasis for acute PUB prevented infections and reduced rebleeding events in cirrhotic patients. Antibiotic prophylaxis improved survival among decompensated cohort following PUB. The Rockall score and rebleeding were predictive risk factors for in-hospital mortality.

Short-term adjusted outcomes for heart failure.

Heart failure (HF) is recognized as a major problem in industrialized countries. Short-term adjusted outcomes are indicators of quality for care process during/after hospitalization. Our aim is to evaluate, for patients with principal diagnosis of HF, in-hospital mortality and 30-day readmissions for all-causes using two different risk adjustment (RA) tools. We used data from the hospital discharge abstract (HD) of a retrospective cohort of patients (2002-2007) admitted in Tuscan hospitals, Italy. Considered outcomes were in-hospital mortality and readmission at 30 days. We compared the All-Patients Refined Diagnosis Related Groups (APR-DRG) system and the Elixhauser Index (EI). Logistic regression was performed and models were compared using the C statistic (C). examined records were 58.202. Crude in-hospital mortality was 9.7%. Thirty-day readmission was 5.1%. The APR-DRG class of risk of death (ROD) was a predictive factor for in-hospital mortality; the APR-DRG class of severity was not significantly associated with 30-day readmissions (P>0.05). EI comorbidities which were more strongly associated with outcomes were nonmetastatic cancer for in-hospital mortality (odds ratio, OR 2.25, P<0.001), uncomplicated and complicated diabetes for 30-day hospital readmissions (OR 1.20 and 1.34, P<0.001). The discriminative abilities for in-hospital mortality were sufficient for both models (C 0.67 for EI, C 0.72 for APR-DRG) while they were low for 30-day readmissions rate (C 0.53 and 0.52). Age, gender, APR-DRG ROD and some Elixhauser comorbidities are predictive factors of outcomes; only the APR-DRG showed an acceptable ability to predict hospital mortality while none of them was satisfactory in predicting the readmissions within 30 days.

0174: Clinical significance of congestive heart failure in prosthetic valve endocarditis. An Algeria multicenter study with 157 patients

There have few studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profileI, and we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis. A total of 439 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 157 were prosthetic. Of the 157 episodes, 88 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis. Persistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5). The incidence of heart failure in patients with prosthetic valve endocarditis is very high.Heart failure increases the risk of in-hospital mortality. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure.

Absence of interaction of diabetes mellitus with chronic kidney disease on mortality in acute heart failure

Objectives: To evaluate how chronic kidney disease (CKD) and diabetes mellitus (DM) influence in-hospital mortality in patients urgently admitted for acute heart failure (HF). Methods: We used data from the Spanish “Minimum Basic Data Set” for 2006–2007 to evaluate clinical differences and crude mortality rates for patients having versus non-having CKD or DM. We tested pre-specified predictive factors of in-hospital mortality in a multivariate logistic regression model, which included age, sex, CKD, DM, acute respiratory failure, a modified Charlson Comorbidity Index—excluding CKD/DM- and a CKD × DM-interaction variable. p Values < 0.05 were considered significant. Main findings: A total of 275,176 episodes of acute HF were analyzed (47.9% male, mean age 76.2 ± 12.8 years). CKD patients (N = 25,174, 9.1%) were older (78.4 ± 10.1 vs. 76.0 ± 13.1 years; p < 0.001) and more frequently had coexisting medical conditions. DM patients (N = 88,994, 32.3%) more often had vascular risk factors and CKD (11.4% vs. 8.1%; p < 0.001). Overall in-hospital mortality rate for admitted HF patients was 10.4%. Mortality was lower for DM versus non-DM patients (9.2% vs. 11.0%; p < 0.001), but higher for CKD versus non-CKD patients (14.1% vs. 10.0%; p < 0.001). No interaction effect was found between CKD and DM on survival for a HF episode (odds ratio; OR = 1.01, 95% CI: 0.91–1.10; p for interaction = 0.73). DM remained protective (OR = 0.85, 95% CI: 0.82–0.87; p < 0.001), while CKD was associated with increased mortality (OR = 1.46, 95% CI: 1.39–1.53; p < 0.001). Conclusions: In patients urgently admitted for HF, the association of CKD with higher in-hospital mortality was homogeneous irrespectively of the absence or presence of DM.

Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock.

Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.

The influential roles of antibiotics prophylaxis in cirrhotic patients with peptic ulcer bleeding after initial endoscopic treatments.

The influential roles of antibiotic prophylaxis on cirrhotic patients with peptic ulcer bleeding are still not well documented. The purpose of this study is to clarify these influential roles and to identify the risk factors associated with rebleeding, bacterial infection and in-hospital mortality. A cross-sectional, chart review study was conducted on 210 cirrhotic patients with acute peptic ulcer hemorrhage who underwent therapeutic endoscopic procedures. Patients were divided into group A (with prophylactic intravenous ceftriaxone, n = 74) and group B (without antibiotics, n = 136). The outcomes were length of hospital days, prevention of infection, rebleeding rate and in-hospital mortality. Our results showed that more patients suffered from rebleeding and infection in group B than group A (31.6% vs. 5.4%; p<0.001 and 25% vs. 10.8%; p = 0.014 respectively). The risk factors for rebleeding were active alcoholism, unit of blood transfusion, Rockall score, model for end-stage liver disease score and antibiotic prophylaxis. The risk factors for infection were active alcoholism, Child-Pugh C, Rockall score and antibiotic prophylaxis. Rockall score was the predictive factor for in-hospital mortality. In conclusions, antibiotic prophylaxis in cirrhotic patients after endoscopic interventions for acute peptic ulcer hemorrhage reduced infections and rebleeding rate but not in-hospital mortality. Rockall score was the predictive factor of in-hospital mortality.

Cytoreductive nephrectomy for metastatic renal cell carcinoma: A population‐based analysis of perioperative outcomes according to clinical stage

To investigate the perioperative outcomes of cytoreductive nephrectomy according to clinical T stage, and to analyze factors affecting these outcomes. The Japanese Diagnosis Procedure Combination database from 2007 to 2012 was used to evaluate perioperative outcomes including in-hospital mortality, complications, blood transfusion, anesthesia time, postoperative length of stay and total cost in patients who underwent cytoreductive nephrectomy for metastatic renal cell carcinoma, according to clinical T stage. Multivariable regression analyses including sex, age, clinical N stage, hospital volume, type of hospital, Charlson Comorbidity Index and clinical T stage were carried out to identify outcome predictors. The present study enrolled 1074 patients including 270 with T1, 215 with T2, 479 with T3 and 110 with T4. Age, sex and Charlson Comorbidity Index were not significantly different among the four stages. A low clinical T stage was associated with minimally-invasive surgery (P < 0.001). The blood transfusion rate, anesthesia time, postoperative length of stay and total cost increased significantly with increasing clinical T stage (all P < 0.001). Multivariable regression analyses showed that increasing clinical T stage was significantly associated with unfavorable perioperative outcomes except in-hospital mortality (T4/T1: postoperative complications OR 2.34; blood transfusion OR 5.27; anesthesia time +14%; postoperative length of stay +13.2%; total cost +13.4%; all P < 0.05). Clinical N stage was the only significant predictive factor for in-hospital mortality (N1/N0: OR 3.34, P = 0.004; N2/N0: OR 3.48, P = 0.008). Clinical T stage is significantly associated with perioperative outcomes, other than in-hospital mortality, in patients with metastatic renal call carcinoma undergoing cytoreductive nephrectomy. Clinical N stage is significantly associated with in-hospital mortality.

MP57-05 PERIOPERATIVE OUTCOMES IN CYTOREDUCTIVE NEPHRECTOMY FOR METASTATIC RENAL CELL CARCINOMA ACCORDING TO CLINICAL STAGE: A POPULATION-BASED ANALYSES

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 2014MP57-05 PERIOPERATIVE OUTCOMES IN CYTOREDUCTIVE NEPHRECTOMY FOR METASTATIC RENAL CELL CARCINOMA ACCORDING TO CLINICAL STAGE: A POPULATION-BASED ANALYSES Toshio Takagi, Toru Sugihara, Hideo Yasunaga, Hiromasa Horiguchi, Kiyohide Fushimi, Tsunenori Kondo, Yukio Homma, and Kazunari Tanabe Toshio TakagiToshio Takagi More articles by this author , Toru SugiharaToru Sugihara More articles by this author , Hideo YasunagaHideo Yasunaga More articles by this author , Hiromasa HoriguchiHiromasa Horiguchi More articles by this author , Kiyohide FushimiKiyohide Fushimi More articles by this author , Tsunenori KondoTsunenori Kondo More articles by this author , Yukio HommaYukio Homma More articles by this author , and Kazunari TanabeKazunari Tanabe More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1780AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives It is important to consider perioperative outcomes when deciding whether cytoreductive nephrectomy (CN) is indicated in patients with mRCC. Although some population based studies analyzed risk factors associated with mortality and morbidity after CN, they had a lack of relation between clinical T stage and perioperative outcomes because of study limitations. We investigated perioperative outcomes after CN according to clinical T stage, and analyzed factors affecting outcomes using Japanese Population database. Methods The Japanese Diagnosis Procedure Combination database from 2007 to 2012 was used to evaluate perioperative outcomes including in-hospital mortality, complications, blood transfusion, anesthesia time, postoperative length of stay (PLOS), and total cost in patients who underwent CN for metastatic renal cell carcinoma, according to clinical T stage. Multivariable regression analyses including gender, age, clinical N stage, hospital volume, type of hospital, Charlson comorbidity index (CCI) and clinical T stage were performed to identify outcome predictors. Results This study enrolled 1,074 patients including 270 with T1, 215 with T2, 479 with T3, and 110 with T4. Age, gender and CCI were not significantly different among the four stages. A low clinical T stage was associated with minimally invasive surgery (p <0.001). The blood transfusion rate, anesthesia time, PLOS, and total cost increased significantly with increasing clinical T stage (all p <0.001). Multivariable regression analyses showed that increasing clinical T stage was significantly associated with unfavorable perioperative outcomes except in-hospital mortality (T4/T1: postoperative complications, OR 2.34; blood transfusion, OR 5.27; anesthesia time, +14%; PLOS, +13.2%; total cost, +13.4%; all p <0.05). Clinical N stage was the only significant predictive factor for in-hospital mortality (N1/N0: OR 3.34, p = 0.004; N2/N0: OR 3.48, p = 0.008). Conclusions Clinical T stage was significantly associated with perioperative outcomes other than in-hospital mortality. Clinical N stage was significantly associated with in-hospital mortality. These results may help surgeons decide indication for CN. Table 2. Surgical outcomes according to clinical T stage Variables T1 T2 T3 T4 p Number 270 215 479 110 In-hospital mortality 9 (3.3%) 5 (2.3%) 14 (2.9%) 8 (7.3%) 0.103 Overall perioperative complications 21 (7.8%) 25 (11.6%) 60 (12.5%) 18 (16.4%) 0.082 Pulmonary embolism 0 (0.0%) 0 (0.0%) 1 (0.2%) 1 (0.9%) 0.260 Cardiacac events 6 (2.2%) 5 (2.3%) 15 (3.1%) 3 (2.7%) 0.876 Stroke 0 (0.0%) 0 (0.0%) 1 (0.2%) 1 (0.9%) 0.260 Pneumonia 1 (0.4%) 0 (0.0%) 2 (0.4%) 1 (0.9%) 0.641 Acute renal failure 1 (0.4%) 0 (0.0%) 3 (0.6%) 1 (0.9%) 0.617 Peritonitis 0 (0.0%) 1 (0.5%) 2 (0.4%) 1 (0.9%) 0.585 Ileus 3 (1.1%) 5 (2.3%) 2 (0.4%) 2 (1.8%) 0.141 Urinary tract infection 0 (0.0%) 4 (1.9%) 6 (1.3%) 0 (0.0%) 0.106 Wound dehiscence 2 (0.7%) 3 (1.4%) 2 (0.4%) 0 (0.0%) 0.392 Sepsis/DIC 4 (1.5%) 4 (1.9%) 15 (3.1%) 6 (5.5%) 0.132 Blood transfusion 37 (13.7%) 75 (34.9%) 220 (45.9%) 62 (56.4%) <0.001 Anesthesia time (median, IQR) 250 (191-310) 275 (220-356) 317 (251-410) 356 (250-450) <0.001 PLOS (median, IQR) 11 (9-17) 13 (9-19) 15 (10-26) 18 (11-36) <0.001 Total cost (US$) (median, IQR) 14539 (11987-18563) 15193 (12356-20282) 16768 (12676-25935) 18682 (15074-29172) <0.001 PLOS: postoperative length of stay,DIC: disseminated intravascular coagulation,IQR: interquartile range © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e642-e643 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Toshio Takagi More articles by this author Toru Sugihara More articles by this author Hideo Yasunaga More articles by this author Hiromasa Horiguchi More articles by this author Kiyohide Fushimi More articles by this author Tsunenori Kondo More articles by this author Yukio Homma More articles by this author Kazunari Tanabe More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Predictors of in‐hospital mortality after acute variceal bleeding in patients with hepatocellular carcinoma and concurrent main portal vein thrombosis

Risk factors for acute variceal bleeding in patients with hepatocellular carcinoma (HCC) and concurrent main portal vein thrombosis (PVT) remain unclear. We aimed to determine risk factors of in-hospital mortality after acute variceal bleeding for HCC patients with concurrent main PVT. We conducted a retrospective analysis of 102 HCC patients (83% men and 17% women) with concurrent main PVT and acute variceal bleeding. All patients received emergent endoscopy to define the bleeding source. Multivariable Cox proportional hazard regression analysis consisting of clinical, laboratory, and endoscopic parameters was performed to identify predictive factors for intrahospital mortality. Twenty-eight (27.5%) patients died within admission. The median survival of all patients was 56 days. Multivariable Cox proportional hazard regression analyses revealed Child-Pugh score (adjusted hazard ratio [aHR]: 1.29 for each point; 95% confidence interval [CI]: 1.11-1.50), active bleeding on index endoscopy (aHR: 7.50; 95% CI: 3.05-18.4), esophageal varices as the bleeder (compared with gastric varices, aHR: 14.3; 95% CI: 3.12-66.1), failure to control bleeding (aHR: 38.0; 95% CI: 7.44-194), and serum creatinine (aHR: 1.28 for each increase of 1 mg/dL; 95% CI: 1.09-1.50) independently predicted in-hospital mortality. Hepatic reserve, active bleeding on index endoscopy, failure to control bleeding, esophageal varices as the bleeder when compared with gastric varices, and renal function were independent predictive factors for in-hospital mortality in HCC patients with acute variceal bleeding and concurrent main PVT.

Albuminuria is a predictive factor of in-hospital mortality in patients with diabetes admitted for foot disease

Albuminuria has been previously reported as a risk factor for mortality in people with diabetes. In a retrospective series of 455 patients with diabetes and foot ulcers, albuminuria was a predictive factor of in-hospital mortality. Other predictive factors were: white blood cell count>12.9×109/L, haemoglobin<108g/L and age >75 years old.

Early and Mid-term Outcomes in Female Patients Undergoing Isolated Conventional Coronary Surgery.

Introduction: Several observational studies comparing outcomes between female and male patients after coronary artery bypass grafting (CABG) have shown that operative mortality rate is higher among female patients than in male patients. However, some conflicting studies report that early mortality among female patients is equivalent to that among male patients. We investigated predictive factors of morbidity, mortality and survival in female patients undergoing isolated conventional CABG. Methods: Between January 2002 and December 2009, 1657 patients underwent isolated conventional CABG in our clinic. 21.8% (n=361) of patients were female and 78.2% (n=1296) males. Results: Advanced age (P<0.0001), hypertension (P<0.0001), diabetes (P<0.0001), and hyperlipidemia (P<0.0001) were the independent predictive factors among female patients. Mean in-hospital mortality rates were 5.8% and 3.2%; for females and males, respectively (P=0.029). Prolonged ventilatory support (P=0.009) and postoperative atrial fibrillation (P=0.049) were the independent predictive factors of in-hospital mortality in female patients. Cardiopulmonary bypass time (P=0.041), prolonged ventilatory support (P<0.0001), and postoperative atrial fibrillation (P=0.031) were the independent predictive factors of in-hospital mortality in male patients. Mean follow-up was 47.51±25.06 months and 48.42±25.21 months among female and male patients (P=0.820). In follow-up, mortality rate was 6.1% (n=22) among female patients and 4.6% (n=60) among male patients (P=0.272). Left internal thoracic artery (LITA) usage (P=0.001) was the independent predictive factor of survival in female patients. Conclusion: In-hospital mortality rate was higher in female patients. Length of ICU and hospital stay, and mid-term survival was similar between female and male patients.

Importancia clínica de la insuficiencia cardiaca congestiva en la endocarditis protésica. Estudio multicéntrico de 257 pacientes

Introduction and objectivesThere have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. MethodsA total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients. ResultsPersistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0,2; 95% confidence interval, 0,1-0,5). ConclusionsThe incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.Full English text available from:www.revespcardiol.org/en

Clinical Significance of Congestive Heart Failure in Prosthetic Valve Endocarditis. A Multicenter Study With 257 Patients

Introduction and objectivesThere have been no studies conducted in the past that focus on the significance of congestive heart failure in patients with prosthetic valve endocarditis. We studied the incidence of congestive heart failure in patients with prosthetic valve endocarditis and analyzed its profile. In this study, we addressed the prognostic significance of heart failure in patients with prosthetic valve endocarditis and analyzed its outcome based on chosen therapeutic strategies. MethodsA total of 639 episodes of definite left-sided endocarditis were prospectively enrolled. Of them, 257 were prosthetic. Of the 257 episodes, 145 (56%) were diagnosed with heart failure. We compared the profiles of patients with prosthetic valve endocarditis based on the presence of heart failure, and performed a multivariate logistic regression model to establish the prognostic significance of heart failure in patients with prosthetic valve endocarditis and identified the prognostic factors of in-hospital mortality in these patients. ResultsPersistent infection (odds ratio=3.6; 95% confidence interval, 1.9-6.9) and heart failure (odds ratio=3; 95% confidence interval, 1.5-5.8) are the strongest predictive factors of in-hospital mortality in patients with prosthetic valve endocarditis. The short-term determinants of prognosis in patients with prosthetic valve endocarditis and heart failure are persistent infection (odds ratio=2.8; 95% confidence interval, 1.2-6.5), aortic involvement (odds ratio=2.5; 95% confidence interval, 1.1-5.8), abscess (odds ratio=3.6; 95% confidence interval, 1.4-9.5), diabetes mellitus (odds ratio=2.9; 95% confidence interval, 1.1-7.7), and cardiac surgery (odds ratio=0.2; 95% confidence interval, 0.1-0.5). ConclusionsThe incidence of heart failure in patients with prosthetic valve endocarditis is very high. Heart failure increases the risk of in-hospital mortality by threefold in patients with prosthetic valve endocarditis. Persistent infection, aortic involvement, abscess, and diabetes mellitus are the independent risk factors associated with mortality in patients with prosthetic valve endocarditis and heart failure; however, cardiac surgery is shown to decrease mortality in these patients.

Impact of coronary artery bypass grafting in elderly patients

To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients > 65 years-old. Patients undergoing isolated on-pump CABG from December 1st 2010 to July 31th 2012 were divided in two groups: GE (elderly > 65 years-old, n=103) and GA (adults < 65 years-old, n=150). Preoperative data, intraoperative (as cardiopulmonar bypass time, aortic clamping time, time length of stay in mechanical ventilation--MV--and number of grafts), and postoperative variable (as morbidity, mortality and time length of stay in hospital) were analyzed during hospitalization. In GE, the morbidity rate was greater than in GA (30% vs. 14%, P=0.004), but there was no difference in the mortality rate (5.8% vs. 2.0%, P=0.165). In GA, there was higher prevalence DM (39.6% vs. 27%, P=0.043) and smoking (32.2% versus 19.8%, P=0.042); and in GE, higher prevalence of stroke (17% vs. 6.7%, P=0.013). There was no difference between the groups regarding intraoperative variables. After multivariate analysis, age > 65-year-old was associated with greater morbidity, but it was not independent predictive factor for in-hospital mortality. Considering in-hospital mortality, stay in ward time length (P=0.006), cardiac (P=0.011) and respiratory complications (P=0.026) were independent predictive factors. This study suggests that patients > 65-year old were at increased risk of postoperative complications when submitted to isolated on-pump CABG in comparison to patients < 65-year-old, but not under increased risk of death.

Impaired left ventricular function as a predictive factor for mid-term survival in octogenarians after primary coronary artery bypass surgery

The impact of preoperative impaired left ventricular ejection fraction (EF) in octogenarians following coronary bypass surgery on short-term survival was evaluated in this study. A total of 147 octogenarians (mean age 82.1 ± 1.9 years) with coronary artery diseases underwent elective coronary artery bypass graft between January 2000 and December 2009. Patients were stratified into: Group I (n = 59) with EF >50%, GroupII (n = 59) with 50% > EF >30% and in Group III (n = 29) with 30% > EF. There was no difference among the three groups regarding incidence of COPD, renal failure, congestive heart failure, diabetes, and preoperative cerebrovascular events. Postoperative atrial fibrillation was the sole independent predictive factor for in-hospital mortality (odds ratio (OR), 18.1); this was 8.5% in Group I, 15.3% in Group II and 10.3% in Group III. Independent predictive factors for mortality during follow up were: decrease of EF during follow-up for more that 5% (OR, 5.2), usage of left internal mammary artery as free graft (OR, 18.1), and EF in follow-up lower than 40% (OR, 4.8). The results herein suggest acceptable in-hospital as well short-term mortality in octogenarians with impaired EF following coronary artery bypass grafting (CABG) and are comparable to recent literature where the mortality of younger patients was up to 15% and short-term mortality up to 40%, respectively. Accordingly, we can also state that in an octogenarian cohort with impaired EF, CABG is a viable treatment with acceptable mortality.

Predictive Factors of In-Hospital Mortality in Colon and Rectal Surgery

Knowledge of the independent risk factors for mortality in colon and rectal surgery can aid surgeons in surgical decision making and in providing patients with appropriate information about the risks of surgery. This study endeavors to identify the risk factors for mortality that are associated with colon and rectal surgery. Using the Nationwide Inpatient Sample database, we examined the clinical data of patients who underwent colon and rectal resection from 2006 to 2008. Multivariate regression analysis was performed to identify factors predictive of in-hospital mortality. A total of 975,825 patients underwent colon and rectal resection during this period. Overall, the rate of in-hospital mortality was 4.50% (elective surgery, 1.42% vs emergent surgery, 8.76%; p < 0.01). Mortality was lower after laparoscopic compared with open operation (1.43% vs 4.74%; p < 0.01). Using multivariate regression analysis, significant risk factors for in-hospital mortality were emergent surgery (adjusted odds ratio [AOR] = 3.53), liver disease (AOR = 3.02), age older than 65 years (AOR = 2.92), total colectomy (AOR = 2.88), chronic renal failure (AOR = 2.37), malignant tumor (AOR = 2.0), open operation (AOR = 1.85), peripheral vascular disease (AOR = 1.81), diverticulitis (AOR = 1.77), transverse colectomy (AOR = 1.43), chronic lung disease (AOR = 1.41), ulcerative colitis (AOR = 1.40), left colectomy (AOR = 1.31), alcohol abuse (AOR = 1.21), male sex (AOR = 1.12), nonteaching hospital (AOR = 1.11), and African-American race (AOR = 1.09). There was no association between hypertension, diabetes, congestive heart failure, obesity, smoking, proctectomy, sigmoidectomy, or Crohn disease and in-hospital mortality. In patients undergoing colorectal surgery, emergent surgery, liver disease, total colectomy, age older than 65 years, chronic renal failure, and malignant tumor are the major risk factors for in-hospital mortality.

Sa1496 Two Decade Overview of the Nationwide Trend of Acute Pancreatitis Hospitalization, in-Hospital Mortality Rate and Predictive Factors of in-Hospital Mortality

Sa1496 Two Decade Overview of the Nationwide Trend of Acute Pancreatitis Hospitalization, in-Hospital Mortality Rate and Predictive Factors of in-Hospital Mortality

Hora da admissão na unidade de emergência e mortalidade hospitalar na síndrome coronária aguda

The relationship between admission time to an emergency service and in-hospital outcomes in acute coronary syndrome (ACS) is controversial. Admission during off-hours would be associated with worse prognosis. To assess the influence of admission time on prolonged hospitalization and mortality for ACS patients, regarding regular hours (7AM-7PM) and off-hours (7PM-7AM). The study assessed prospectively 1,104 consecutive ACS patients. In-hospital mortality and length of hospital stay ≥ 5 days were the outcomes analyzed. Admission during regular hours was greater as compared with that during off-hours (63% vs. 37%; p < 0.001). Unstable angina was more prevalent during regular hours (43% vs. 32%; p < 0.001), while non-ST-segment elevation myocardial infarction (NSTEMI) was during off-hours (33% vs. 43%; p = 0.001). Differences in neither mortality nor length of hospital stay were observed in the time periods studied. Predictive factors for length of hospital stay ≥ 5 days were as follows: age [OR 1.042 (95%CI: 1.025 - 1.058), p < 0.001]; ejection fraction (EF) [OR 0.977 (95%CI: 0.966 - 0.988), p < 0.001]; NSTEMI [OR 1.699 (95%CI: 1.221 - 2.366), p = 0.001]; and smoking [OR 1.723 (95%CI: 1.113 - 2.668), p = 0.014]. Predictive factors for in-hospital mortality were as follows: age [OR 1.090 (95%CI: 1.047 - 1.134), p < 0.001]; EF [OR 0.936 (95%CI: 0.909 - 0.964), p < 0.001]; and surgical treatment [OR 3.781 (95%CI: 1.374 - 10.409), p = 0.01]. Prolonged length of hospital stay and in-hospital mortality in ACS patients do not depend on admission time.